Wednesday, August 03, 2011

Blind Faith

I know another mom-of-toddler who's also pregnant. She did the 1-hour glucose tolerance test and 'failed' marginally. "What did you do?" she asked.

"I read all the recent articles on it, and declined it," I said.

"I don't want to do the three-hour one," she said, "and I read a whole bunch of articles about it and I'm low-risk and I didn't have GD last time... but I'll see what my doctor says. I'll probably have to do it anyways."

Um.... what? The premise that Doctor Always Knows Best is fundamentally flawed, and the premise that every intervention should be accepted is also flawed. And this isn't a high-risk situation, either. (Her last kid was 7 pounds.) I will never understand this (culturally conditioned) impulse to accept a doctor's word as wisdom from on high.

Of course, during the whole unfortunate double vision saga, one particularly stupid ER doctor said cheerily to me "We think you might have multiple sclerosis!" and I thought "Like hell I do. 'Rule out' is not the same as 'you have', moron."*

*What I actually said, because I just wanted to get an MRI and leave, was "Mmm-hmm. We'll see." But what I thought was "Fuck off and die, idiot." Lo and behold, I did not have MS. Or a brain tumor. Or whatever other horrible but unlikely thing the idiot resident suggested.

3 comments:

Hi Jenny - I just found your blog and really like it. I was a scientist until I had a baby 8 months ago, and now I'm thinking about entering the blogging/writing world. Anyway, back when I was in the lab I studied the effects of gestational hyperglycemia on the fetus, specifically the pancreas. Diabetes during pregnancy is linked to a host of problems in the baby. Besides growing a big baby and all the complications that can come with that, your kid is more likely to grow up to be diabetic and then expose their kids to diabetes during pregnancy. Hyperglycemia during pregnancy programs the pancreas to fail later. Yikes. So I have to disagree - I do think it is important to screen for GD. The test is very safe, and if it comes up positive, most women can adequately control their glucose with diet, as much as that sucks for a grumpy, hungry, toddler-chasing, pregnant mama. Although I disagree with you on this point, I do whole-heartedly agree that we should never blindly follow a doctor's advice. I'm married to a doctor, and he is wrong all the time. "Honey, I saw you just look that up on Wikipedia. Come back to me after you've checked a few peer-reviewed sources."

SM: the cutoffs vary widely by individual doctor, and while I agree that the effects can be bad, there's not a convincing linkage between low-end "GD" and the later symptoms. If you fail at 150% of the recommended value, sure, but by 2 points, the evidence seems to indicate that in the absence of macrosomia, in borderline cases, actually nothing bad is happening. But yeah, it's more about trust vs. skepticism. More the "I don't want it and I don't think I need it but I'll do it because my doctor says so."

Fair enough. If you are 2 points over, it probably doesn't matter too much what you do, assuming that your doctor uses a more conservative cutoff rather than a more liberal one. There are several big recent studies that show that even at the low end of hyperglycemia, risks to the fetus are increased. I guess I'd want to know even if I was in that marginal area so that I could check myself every once in a while to make sure I was keeping my glucose within bounds. On the flip side, a close friend of mine was diagnosed with GD while we were both pregnant. She fretted about it constantly and always felt like she was endangering her baby when she so much as ate a sugary Tums. I passed the test with flying colors and ate whatever I wanted - mostly ice cream given that I was pregnant through the summer in Arizona. She had a 7 lb baby; I had an 8 lb 9 oz chunker. But like I said, I think macrosomia is not necessarily the worst outcome of GD. Sorry for rambling on - I've been stuck at home with my 8-month-old with no adults to talk to for too long!

About Me

I'm a Southerner who has moved back to the Rural South; my spouse has just gotten the golden ring (a tenure-track job); deeply tired of being ill. I knit, I write, I bake things that won't kill me. I make - and wear! - ridiculous hats.

DISCLAIMER: I am a scientist, not a medical professional. THIS IS NOT MEDICAL ADVICE, these are my personal opinions. I intend these only as academic summaries of the available evidence. If you require medical advice or assistance, please consult your health care provider